Acute Care Learning Laboratory - Reducing Threats to Diagnostic Fidelity in Critical Illness

项目总结/摘要 尽管认识到诊断错误和延误是造成可预防死亡的主要因素， 在美国，在减少这种已知杀手的死亡率方面几乎没有取得进展。虽然有 大量的文献概述了促成原因，一个有效的战略，导致有意义的 降低诊断错误率和延迟率尚未付诸实践。这至少在一定程度上是 由于执行不力，重点放在医疗团队的作用上， 临床环境中组织和系统流程的复杂性。这项建议是 独特新颖，将混合方法研究方法与系统工程研究相结合 了解导致诊断错误和延迟的多种因素的相互作用的方法。的 从这种整体方法中获得的知识将用于学习实验室， 设计、开发、评估和改进诊断错误和延迟的解决方案。“控制塔” 将是现场学习实验室的舞台，并将建立在一个完善的临床实验室之上。 信息学基础设施和医院环境对创新和实践变革开放。具体而言，使用 这种创新的方法，我们将评估学习实验室干预的有效性， 诊断错误和延误的病人出现严重的疾病。通过以下方式制定的干预措施 “控制塔”有可能与多个实践共享，并适用于各种临床 环境.

Project Summary/Abstract Despite the recognition that diagnostic errors and delays are a major contributor to preventable deaths in the USA, little progress has been made to reduce mortality outcomes from this known killer. Although there is a considerable body of literature outlining contributing causes, an effective strategy leading to a meaningful reduction in diagnostic error and delay rates has not made its way into practice. This has, at least in part, been due to ineffective implementation that has focused on the healthcare team's role and has failed to incorporate the complexity of the organizational and systems processes within the clinical environment. This proposal is unique and novel and combines mixed-methods research approaches with systems engineering research approaches to understand the interplay of the multiple factors contributing to diagnostic error and delay. The knowledge gained from this holistic approach will then be used within the learning laboratory to inform the design, development, evaluation, and refinement of the solutions to diagnostic error and delay. “Control Tower” will be the staging ground for the in situ learning laboratory and will be built on top of a well-established clinical informatics infrastructure and hospital environment open to innovation and practice change. Specifically, using this innovative approach we will evaluate the effectiveness of learning laboratory interventions on the rate of diagnostic error and delay in patients with emerging critical illness. The interventions developed through “Control Tower” have the potential to be shared with multiple practices and adapted to a variety of clinical environments.